Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study
[Postoperative analgesia of continuous intravenous fentanyl or dexmedetomidine for patients receiving anticoagulant therapy].
It is difficult to achieve good postoperative analgesia in patients who undergo abdominal aortic surgery without epidural analgesia and who have a bleeding tendency or are undergoing anticoagulation therapy. Intravenous fentanyl analgesia can be used in such patients, but it occasionally causes respiratory depression. Dexmedetomidine is used to achieve postoperative sedation and analgesia without respiratory depression. We compared the methods used to achieve postoperative analgesia after abdominal aortic surgery. ⋯ With regard to respiratory depression, intravenous dexmedetomidine analgesia is safer and more useful than intravenous fentanyl analgesia.
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Motor evoked potential (MEP) monitoring has been employed to detect the spinal cord injury during spinal, neurosurgical and cardiovascular operations. Muscle relaxants diminish the amplitude of MEP because MEP is the picture of electromyogram. In 5 cases undergoing MEP monitoring, we examined the effect of rocuronium followed by the administration of sugammadex on MEP Anesthesia was induced with propofol (target controlled infusion 3.0-3.5 microg x ml(-1)) and remifentanil 0.15-0.3 microg x kg(-1) x min(-1), and the trachea was intubated with the use of rocuronium 0.6 mg x kg(-1) without any muscle rigidity, bucking and laryngospasm. ⋯ Sugammadex restored the MEP amplitude, deteriorated by rocuronium, in 3 to 5 min to the level of non-paralytic muscles. In one case, it took 8 min to restore the MEP of hemiparetic leg. Taking these findings into consideration, it is likely that rocuronium might not affect the MEP when reversed by sugammadex, and should be safe for smooth tracheal intubation in patients who need MEP monitoring.
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Comparative Study
[Comparison of intrathecal morphine and buprenorphine for postoperative analgesia in cesarean delivery].
It has become a popular practice to add opioids to spinal solutions to enhance and prolong intraoperative and postoperative analgesia in cesarean section. Morphine is the opioid most widely used for this purpose, but there are few reports about intrathecal buprenorphine. We evaluated the postoperative analgesic effect of intrathecal buprenorphine compared with intrathecal morphine after cesarean section. ⋯ It is concluded that intrathecal buprenorphine 0.05 mg provides similar postoperative analgesic effect with intrathecal morphine 0.1 mg without any increases of side-effects in cesarean section.
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A 49-year-old female with mitochondrial encephalomyopathy underwent laparoscopic cholecystotomy. She had some characteristic clinical symptoms, including muscle weakness, deafness, hemianopia and elevation of lactic acid level in the blood. It has been considered that problems of anesthesia for patient with mitochondrial encephalomyopathy are relevant to malignant hyperthermia, respiratory depression due to muscle weakness and probability of hyperlactacidemia. ⋯ Arterial blood gases and pH were checked and acetated electrolyte solution was infused mainly during surgery. No complications occurred during anesthesia and this patient showed smooth recovery from anesthesia. Her postoperative course was uneventful.
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We experienced anesthetic management of a patient with Becker muscular dystrophy. He had advanced dilated cardiomyopathy and high serum CK in the preoperative examinations. Anesthesia was planned to avoid triggering malignant hyperthermia or rhabdomyolysis and hemodynamic changes. ⋯ Arterial pressure, cardiac output and stroke volume variation were monitored by Flotrac sensor. There were no adverse events observed during the anesthetic management. In conclusion, total intravenous anesthesia with the administration of rocuronium and circulatory monitoring by Flotrac sensor could be safe and efficient for anesthetic management of patients with Becker muscular dystrophy.